Citation

Ruggiero KJ, Davidson TM, Anton MT, Bunnell B, Winkelmann J, Ridings LE, Eilers O, Crookes B, McElligott J, Fakhry SM. J. Am. Coll. Surg. 2020; ePub(ePub): ePub.

Affiliation

Department of Surgery, College of Medicine, MUSC, Charleston, SC.

Copyright

(Copyright © 2020, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2020.03.037

PMID

32335320

Abstract

BACKGROUND: Annually, over 400,000 adults served in U.S. trauma centers (≥ 20%) develop posttraumatic stress disorder and/or depression in the first year after injury. Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations. STUDY DESIGN: This paper describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma activation patients admitted to our Level I trauma center for at least 24 hours were approached prior to discharge. Patients were provided education in person at the bedside (Step 1), symptom monitoring via a 30-day text-messaging tool (Step 2), telephone screening ∼30 days post-injury (Step 3), and, when appropriate, mental health treatment referrals/treatment (Step 4).

RESULTS: We approached and educated 1,122 (56%) patients on the floor over a 33-month period. Of these, 1,096 (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of whom screened positive for PTSD and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals.

CONCLUSION: This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.

Copyright © 2020. Published by Elsevier Inc.

Language: en

Keywords

depression; injury; mental health; posttraumatic stress disorder; trauma center